Department of Medicine, Section of Nephrology and Dialysis, G. d'Annunzio University, Chieti-Pescara, Chieti, Italy.
Warwick Medical School, University of Warwick, Clinical Sciences Research Institute, Coventry, England.
J Nephrol. 2021 Apr;34(2):503-519. doi: 10.1007/s40620-020-00804-2. Epub 2020 Aug 7.
Peritoneal dialysis (PD) is a viable but under-prescribed treatment for uremic patients. Concerns about its use include the bio-incompatibility of PD fluids, due to their potential for altering the functional and anatomical integrity of the peritoneal membrane. Many of these effects are thought to be due to the high glucose content of these solutions, with attendant issues of products generated during heat treatment of glucose-containing solutions. Moreover, excessive intraperitoneal absorption of glucose from the dialysate has many potential systemic metabolic effects. This article reviews the efforts to develop alternative PD solutions that obviate some of these side effects, through the replacement of part of their glucose content with other osmolytes which are at least as efficient in removing fluids as glucose, but less impactful on patient metabolism. In particular, we will summarize clinical studies on the use of alternative osmotic ingredients that are commercially available (icodextrin and amino acids) and preclinical studies on alternative solutions under development (taurine, polyglycerol, carnitine and xylitol). In addition to the expected benefit of a glucose-sparing approach, we describe an 'osmo-metabolic' approach in formulating novel PD solutions, in which there is the possibility of exploiting the pharmaco-metabolic properties of some of the osmolytes to attenuate the systemic side effects due to glucose. This approach has the potential to ameliorate pre-existing co-morbidities, including insulin resistance and type-2 diabetes, which have a high prevalence in the dialysis population, including in PD patients.
腹膜透析（PD）是一种可行但未被充分应用的尿毒症患者治疗方法。人们对其使用存在一些担忧，包括 PD 液的生物不相容性，因为它们可能改变腹膜的功能和解剖完整性。这些影响中的许多被认为是由于这些溶液的高葡萄糖含量引起的，伴随而来的还有在含有葡萄糖的溶液热处理过程中产生的问题。此外，从透析液中过度吸收腹腔内的葡萄糖会对全身代谢产生许多潜在影响。本文综述了开发替代 PD 溶液的努力，这些溶液通过用其他渗透剂替代部分葡萄糖含量来避免这些副作用，这些渗透剂在去除液体方面至少与葡萄糖一样有效，但对患者代谢的影响较小。特别是，我们将总结关于替代渗透剂（艾考糊精和氨基酸）的临床研究和正在开发的替代溶液（牛磺酸、聚甘油、肉毒碱和木糖醇）的临床前研究。除了节省葡萄糖的预期益处外，我们还描述了一种在配制新型 PD 溶液时的“渗透代谢”方法，其中有可能利用一些渗透剂的药物代谢特性来减轻葡萄糖引起的全身副作用。这种方法有可能改善现有的合并症，包括胰岛素抵抗和 2 型糖尿病，这些疾病在透析人群中包括 PD 患者中患病率很高。
